# Lessons learned while exploring the impact of movement-tracking feedback on the experiences of children with neuromotor disorders taking part in interactive home exercise programs: a multi-case mixed methods study

## TL;DR

This study explores how movement-tracking feedback in an interactive home exercise game affects children with cerebral palsy and their parents.

## Contribution

The study introduces a mixed methods approach to evaluate how movement-tracking feedback influences engagement and adherence in home exercise programs for children with CP.

## Key findings

- Feedback positively impacted exercise adherence for two children, with one showing significant improvement.
- Parents found feedback useful for understanding movement quality, though children had mixed perceptions of its fun and helpfulness.
- Technical issues caused frustration, but all participants preferred the interactive program over conventional home exercises.

## Abstract

Home exercise programs prescribed to children with cerebral palsy (CP) are often associated with low adherence. Interactive technologies can help motivate and guide children through exercise programs at home, reducing onus on parents. This study sought to understand the impact of movement-tracking feedback on children’s engagement and parents’ experiences within an interactive computer play home exercise program (ICP-HEP), Bootle Boot Camp.

A multi-case mixed methods study was conducted with three children with CP and their parents. In the quantitative single case experimental design with alternating treatments phase, children used the ICP-HEP with and without movement-tracking feedback for four weeks, and exercise adherence, exercise fidelity (movement performance quality), perceived level of fun and helpfulness for the body (i.e., 5-point rating scales and survey) were evaluated. The version (feedback/no feedback) with the highest exercise adherence was carried out for two additional weeks. Dyadic (child/parent) qualitative interviews followed. Quantitative data were analyzed using visual and statistical approaches. Qualitative data were analyzed using directed content analysis. Quantitative and qualitative results were merged through narrative weaving and joint displays.

Accuracy of the movement tracking and feedback provided varied among children, exercises, and play environments. Feedback may have contributed positively to exercise adherence for two children, with a significant enhancement (p < 0.001) for one of these children, and no observed negative impacts for the third child. Parents and one child perceived feedback as generally being useful for learning about movement quality, however when perceived to be inaccurate, it may have been ignored. While children had varied perspectives on how fun and helpful feedback was, it was valued by all parents. All children experienced some frustration due to sporadic technical issues. All children/parents preferred Bootle Boot Camp over conventional home programs, and suggested game refinements to enhance this ICP-HEP experience.

Use of an interactive therapy game has the potential to support children’s adherence to and children’s/parents’ experiences with home exercise, with feedback impacting children differently based on personal and environmental factors. This study serves as a foundation for future game refinements and larger-scale testing that will continue to explore the impact of feedback within an ICP-HEP.

Trial registration: NCT05998239.

The online version contains supplementary material available at 10.1186/s12984-025-01819-1.